Cureus. 2026 Sep 25;18(9):e116911. doi: 10.7759/cureus.116911. eCollection 2026 Sep.
ABSTRACT
Janus kinase inhibitors are increasingly used in dermatology and rheumatology, but concerns about cardiovascular events, thromboembolism, and malignancy continue to influence long-term treatment decisions. This narrative comparative review examines evidence from randomized trials, integrated safety analyses, long-term extensions, selected observational studies, and regulatory sources, focusing on rheumatoid arthritis, psoriatic arthritis, atopic dermatitis, and alopecia areata. Topical agents and selective tyrosine kinase 2 inhibition are considered separately because of important differences in systemic exposure and pharmacology. The original, informally assembled evidence base was supplemented by a targeted literature update. ORAL Surveillance identified an important safety signal for tofacitinib compared with tumor necrosis factor inhibitors in patients with rheumatoid arthritis and cardiovascular risk factors. Long-term dermatology studies have generally reported low absolute event rates, although younger study populations, restrictive eligibility criteria, limited long-term comparator data, and treatment discontinuation affect how these findings should be interpreted. Observational studies in dermatology have produced mixed results, including thromboembolic associations that warrant further investigation. Psoriatic arthritis provides additional evidence across the clinical boundaries of both specialties. Differences in patient populations, study design, outcome definitions, and statistical measures limit direct comparisons across studies. Treatment decisions should follow indication-specific prescribing requirements and consider cardiovascular disease, prior thrombosis, smoking, age, malignancy history, and available alternatives. Additional long-term comparative studies are needed to better distinguish patient-, disease-, and treatment-related risks.
PMID:42928856 | PMC:PMC13696063 | DOI:10.7759/cureus.116911